Natural remedies for irritable bowel syndrome (IBS)

It’s not often that I recommend natural remedies because there’s rarely any scientific evidence that they work better than a placebo. But when there’s data supporting their use I’m all for it. Such is now the case in the treatment of irritable bowel syndrome (IBS) as shown by a review of research recently published in the British Medical Journal. Turns out that two of the best treatments for IBS, peppermint oil and fiber, are old-fashioned, inexpensive and widely available over-the-counter (OTC). And I don’t mean that these are just two of the best natural remedies or two of the best OTC remedies, they are two of the best remedies period.

The research review found three IBS treatments to be consistently better than placebo. In addition to peppermint oil and fiber, the anti-spasmodic scopolamine (also called hyoscine), a natural product derived from certain plants, is also effective – but, because it can be quite dangerous when misused, it’s only available by prescription in the U.S.

As many as 20 percent of Americans have IBS, making it one of the most common disorders that doctors see. Its symptoms include crampy abdominal pain, gas and bloating, and either diarrhea or constipation (or both, sometimes they alternate). One of the most important facts about IBS is that it is a so-called functional disorder, meaning that it doesn’t have an underlying structural cause. This distinguishes it from two other chronic digestive illnesses that are caused by inflammation, Crohn’s disease and ulcerative colitis, each of which is referred to as an inflammatory bowel disease or IBD. Because of the similarity of the words irritable and inflammatory, and the acronyms IBS and IBD, people often get these conditions mixed up.

There are two things to know about fiber in treating IBS. One is that it’s probably best for people who have constipation-predominant IBS, and the other is that the type of fiber chosen is important. In this regard, soluble fiber is better than insoluble fiber. Foods containing insoluble fiber include wheat bran, corn bran, plums and prunes. Foods containing soluble fiber include oats, legumes (peas, beans, lentils), fruits and berries. Another source of soluble fiber is dietary supplements containing psyllium, such as Metamucil. Fiber should be increased gradually because it could exacerbate symptoms. Only trial and error will enable you to determine whether it works in your situation. If you’re using a psyllium supplement, start with one half to one tablespoon per day (Metamucil contains 3 grams of fiber per tablespoon). Most positive studies have used between 10 and 30 grams of fiber per day.

The research review found that the best treatment for IBS is peppermint oil, which acts as an antispasmodic in the intestinal tract. Although peppermint tea is widely used to aid digestive troubles, if you’re treating IBS it’s probably better to take a standardized dosage on a consistent basis. For this you’ll probably want to get capsules and the best of these are enteric-coated, meaning that they have a special covering that prevents breakdown in the stomach, which can cause heartburn, and allows for passage down through the intestines for proper absorption. The dose can be a bit confusing. Some capsules are described by volume (mL) and some by weight (mg). When described by volume, the amount per capsule is 0.2 – 0.4 mL and you should take one capsule three times a day. When described by weight, the amount per capsule is about 200 mg, again taken three times a day.

As with all chronic medical conditions, I recommend you see your doctor for a full diagnostic workup to make sure that you actually have IBS and to rule out other more serious conditions. Your doctor can also give you other important information such as dietary recommendations and can help you determine whether, or when, prescription medications might be in order. Not long ago, HealthTalk had a webcast on avoiding an incorrect diagnosis in IBS and IBD that you might find interesting. Our chronic pain blogger has written about IBS too. And our disease encyclopedia has information on IBS as well.

Do you have experience taking fiber, peppermint oil or other natural remedies for IBS? If so, please post a comment below so that others can learn from your experience. We look forward to hearing from you.

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ABOUT THE AUTHOR

Ed Zimney, MD

Ed is a physician with more than 30 years of experience. He’s held positions in drug advertising review, drug safety surveillance, medical information and marketing with several bio/pharmaceutical companies.